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Published on: November 7, 2020
Early post-liver transplantation infections and their effect on long-term survival
Yaara Leibovici-Weissman1,2,3, Noa Anchel3, Eviatar Nesher3,4
1Department of Medicine D, Rabin Medical Center, Liver Institute, Beilinson Hospital, Petah-Tikva, Israel.
Background:
Infections post-liver transplantation are major drivers for morbidity and mortality. However, the impact of infections within 180 days post-liver transplantation on long-term survival is not clear.
Methods:
We present a retrospective cohort of 317 liver transplant patients for whom all infectious episodes were prospectively collected during a mean follow-up of 4.4 years.
Results:
A total of 143/317 (45%) of patients suffered from any infectious episode during the first 6 months following liver transplantation. Patients with surgical site infections have a reduced survival compared to those with no infection (HR 0.33, 95% CI 0.172-0.636, P = .001), whereas infections from other sources, including pneumonia, UTI, and line-related infections, were not associated with increased mortality. Furthermore, even though the presence of any infection within 30 days or 6 months post-transplantation did not affect survival, more than a single infectious episode per patient was significantly associated with increased mortality (HR 1.70, CI 1.12-2.60, P = .013). In a multivariate analysis, the number of infectious episodes remained statistically significant (HR 1.58, 95% CI 1.03-2.43, P = .035) upon adjustment for other major variables associated with comorbidities and infection risk.
Conclusions:
Surgical site infections and the number of infectious episodes within 180 days post-liver transplantation are major determinants of long-term survival among these patients.
Insights
Post-liver transplant infections, particularly surgical site infections and multiple episodes, significantly impact long-term patient survival. Early detection and management are crucial for improving outcomes after liver transplantation.
Area of Science:
- Transplantation Immunology
- Infectious Diseases
- Surgical Outcomes
Background:
- Infections following liver transplantation are a primary cause of patient morbidity and mortality.
- The specific impact of early infections (within 180 days) on long-term liver transplant survival remains unclear.
Purpose of the Study:
- To investigate the association between early post-liver transplant infections and long-term patient survival.
- To identify specific types and frequencies of infections that influence long-term outcomes.
Main Methods:
- Retrospective cohort study of 317 liver transplant recipients.
- Prospective collection of all infectious episodes over a mean follow-up of 4.4 years.
- Multivariate analysis to adjust for comorbidities and infection risk factors.
Main Results:
- 45% of patients experienced infections within 6 months post-transplant.
- Surgical site infections were linked to reduced survival (HR 0.33, P=.001).
- Multiple infectious episodes (≥1 per patient) significantly increased mortality risk (HR 1.70, P=.013), a finding sustained in multivariate analysis (HR 1.58, P=.035).
Conclusions:
- Surgical site infections and the number of infectious episodes within 180 days post-liver transplant are critical determinants of long-term survival.
- These findings highlight the importance of infection control and management in the early post-transplant period.
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